RESEARCH PROJECT: ABSTRACT Nephrolithiasis (or commonly known as urinary stone disease) is a benign but severely painful genitourinary disease that is on the rise and is the second most costly urologic condition in the US at over $2 billion per year. The treatment of nephrolithiasis is shifting away from shock wave lithotripsy (SWL) to intracorporeal laser lithotripsy (LL) via ureteroscopy, which is expanding rapidly to become the most common surgical modality for managing stone patients. This shift in treatment paradigm has paralleled advances in endoscopic and LL technologies, but the foundational knowledge of laser-stone-tissue interaction and LL technology has not advanced commensurably with its growing use in clinical care. To optimize LL for long-term surgical management of stone disease will require interdisciplinary teams of engineers, materials scientists, and photonics experts to work in close collaboration with urologists to maximize translational impact. The overarching goal of this P20 application is to develop a Center for Urological Laser Technologies (CULT) at Duke University that will synergistically combine the expertise in SWL and LL research, photonics and clinical expertise in nephrolithiasis to better understand the dissimilar laser technologies and techniques used clinically for stone management. The center's team will consist of investigators with expertise in urology, biophotonics, heat transfer, computational mechanics, and materials science to address the challenges faced in advancing laser technologies to treat stone disease. The center's Research Project has two Specific Aims focusing on (1) comprehensively characterizing the optical, thermal, acoustic, and mechanical properties of kidney and artificial stones of different compositions and investigate the dissimilar mechanisms of stone damage produced by various modes of LL; and (2) performing an in-depth analysis of laser-induced cavitation bubble dynamics in correlation with stone retropulsion and treatment efficiency produced by different LL devices. With the completion of these two specific aims and associated educational activities, we envision that the center will produce a timely and significant impact on advancing our knowledge about the various LL technologies used in clinic. Given the growing epidemic of urinary stone disease, the establishment of the CULT at Duke will build an infrastructure to promote interdisciplinary research collaborations between engineering and urology that can be sustained through follow-up R01, P01, or U54 applications to benefit the long-term surgical management of stone patients.